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277CA enhanced messaging to meet evolving business needs

Due to technology advances an increase in detailed payer business requirements and data quality rules are being migrated upfront in the claim validation workflow front end system. There is a business need to evolve and improve claim rejection messaging between payers and providers.

This creates a business need for more sophisticated and business-focused messaging in the 277CA beyond the reporting of acceptance or rejection of health care claims. These pre-adjudication edits replace costly and time intensive claim denials with timely provider front-end claim rejections. These policy, plan benefit, billing, and regulatory requirement rules are often highly specific and unique, requiring detailed provider claim correction messaging clarification to further support the fully codified STC01, 10, and 11.

This change request is to enhance the 277CA to meet these evolving business needs within the claim status rejection workflow to provide a precise, actionable, and comprehensive message which allows providers to quickly identify, correct, and resubmit rejected claims and lessen provider dependency on payer portals and manual outreach.

A common goal for all health care stakeholders is to continue to enhance the 277 standard to drive workflow automation, reduce administrative costs, improve first time claim acceptance rates, and avoid interruptions to provider claim processing, payment, and cash flow.